Professor Derek O’Reilly Photo: Courtesy of BJU

 
The burden of injury is a universal public health challenge that afflicts every country in the world with cases distributed across all ages and both sexes. Among different causes of injury in China, the most common are road injuries, falls and drowning. Violence is not a common cause, unlike, for example, in the US, and when it does occur, self-harm is far more common than interpersonal violence.

In China, rapid economic development, urbanization, motorization, aging, and environmental and lifestyle changes over the past three decades have led to injury being reported as the fifth leading cause of death, Professor Derek O'Reilly from the Beijing United Family Hospital (BJU) said.

A recent "Global Burden of Health" study showed that, although the incidence of injuries in China has increased, with the expansion of the economy, the mortality and disability rates have declined. "This suggests that the rapid socioeconomic development in China might have increased the risk of injury, but that improvements in health-care have led to large improvements in mortality from trauma," the professor noted.

The BJU has had a "code trauma" rapid response policy and trauma team system in place for many years, Dr Martin Springer said, adding that the emergency room physician, upon the realization that a trauma patient is present, either upon arrival or by prior notification by the emergency medical service, activates the trauma code. 

The following additional trauma team members are expected to be present to the ER within five minutes: the first-line general surgeon, intensive care physician, anesthesiologist, laboratory and blood bank technician, radiology technician, hospital supervisor and patient service staff. Senior surgical and anaesthetic staff are expected to be called early during the trauma resuscitation. Senior physicians from different specialties (such as ENT, plastic surgery, ophthalmology, neurosurgery, orthopedics and cardio-thoracic surgery) are called as needed.

Recently, a serious earthquake occurred in Luding, Southwest China's Sichuan Province. Martin said the disaster is an example of how improved trauma care can contribute to lower levels of death and disability following natural phenomenon. Trauma care begins at the time of injury, and the sooner effective treatments are begun, the better the outcomes, he said.

According to the doctor, the most immediate life-threatening injury is catastrophic bleeding and, increasingly, hospital-based care is being moved out to the pre-hospital setting. The first "golden" hour of care after injury is characterized by the need for rapid assessment and resuscitation, which are the fundamental principles of trauma care. 

"Members of the public can provide life-saving treatment too, simply by applying pressure to an obviously bleeding wound or by applying a tourniquet, which could be a belt or a tie, above a bleeding wound in the arms or legs," he added.

The management of trauma is especially challenging for clinicians, Derek said, as trauma patients present with life-threatening injuries. The standard sequence of medical practice is not possible due to the critical urgency with which these patients present. This led to the development of the Advanced Trauma Life Support (ATLS) and other courses which emphasized the need to treat the greatest threat to life first.

"The Beijing 'Great Wall Practical Trauma Course' is a unique and bespoke training to address the needs of our front-line doctors from BJU as well as other hospitals across China. Our international keynote speakers were able to emphasize the most up-to-date strategies for dealing with trauma patients that other courses may not have incorporated yet," the professor noted.

For example, Dr Feng Juefei from Singapore emphasized team-working and preparation before the trauma patient arrives, and Prof Karim Brohi from London, the UK spoke about the counter-intuitive concept of "hypotensive resuscitation" - not resuscitating too much in order to protect the blood clots that have already formed. Professor Mark Midwinter from Sydney, Australia spoke about the new concept of "damage control" - addressing the physiological consequences of trauma, aimed in particularly at the failure of blood clotting, from the outset of resuscitation, coupled with early or concurrent surgery.

"These developments have the potential to greatly improve outcomes in trauma management," Derek said.